A pitfall in diagnosing Cushing’s disease: ectopic ACTH-producing pituitary adenoma in the sphenoid sinus
| العنوان: | A pitfall in diagnosing Cushing’s disease: ectopic ACTH-producing pituitary adenoma in the sphenoid sinus |
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| المؤلفون: | B. Winterberg, Jörg Flitsch, Christian Bernreuther, M.M Ritter, Hendrik Lehnert, Till Burkhardt, Sebastian M. Schmid |
| المصدر: | Pituitary. 18:279-282 |
| بيانات النشر: | Springer Science and Business Media LLC, 2014. |
| سنة النشر: | 2014 |
| مصطلحات موضوعية: | Adenoma, Pathology, medicine.medical_specialty, ACTH-Secreting Pituitary Adenoma, Sphenoid Sinus, Biopsy, Endocrinology, Diabetes and Metabolism, medicine.medical_treatment, Choristoma, Petrosal Sinus Sampling, Endocrinology, Predictive Value of Tests, Pituitary adenoma, medicine, Humans, Pituitary ACTH Hypersecretion, Ectopic pituitary adenoma, Transsphenoidal surgery, business.industry, Pituitary ACTH hypersecretion, Cushing's disease, Middle Aged, medicine.disease, Immunohistochemistry, Magnetic Resonance Imaging, ACTH Syndrome, Ectopic, Female, Radiology, business, Paranasal Sinus Neoplasms |
| الوصف: | To show a rare case of Cushing's disease and possible cause of failed transsphenoidal surgery.We report on a 50-year-old woman suffering from ACTH-dependent Cushing's syndrome. Endocrinological work-up including low-dose/high-dose dexamethasone test (Liddle-test) and CRH test were clearly compatible with pituitary origin. Although an MRI showed no pituitary tumor, CRH-stimulated petrosal sinus sampling revealed a significant central-peripheral gradient in ACTH concentrations, rendering Cushing's disease very likely. The patient underwent transsphenoidal surgery with negative exploration of the pituitary gland. After intraoperative re-evaluation of the preoperative MRI, a "polyp" at the bottom of the sphenoid sinus was identified. The intraoperative microscopic aspect as well as instantaneous sections and cytology of a biopsy confirmed an adenoma, which was then removed. Histological analysis demonstrated an ACTH-producing pituitary adenoma adjacent to respiratory mucous membrane consisting of ciliated epithelium with submucous connective tissue. Postoperatively, ACTH concentrations were decreased and intermittent hydrocortisone substitution treatment was initiated. At the 3-month follow up, Cushing's stigmata were found to be alleviated and the hydrocortisone dosage could be reduced.Ectopic pituitary adenoma tissue causing Cushing's disease is extremely rare but a potential cause for surgical failure or re-evaluation. |
| تدمد: | 1573-7403 1386-341X |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::0468f741aa8d94589f7f174bd332078bTest https://doi.org/10.1007/s11102-014-0591-8Test |
| حقوق: | CLOSED |
| رقم الانضمام: | edsair.doi.dedup.....0468f741aa8d94589f7f174bd332078b |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 15737403 1386341X |
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